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Paediatrica IndonesianaVOLUME 53 NUMBER 5September 2013

Original Article

Paediatr Indones, Vol. 53, No. 5, September 2013 287

Cotinine and interferon-gamma levels in pre-school

children exposed to household tobacco smoke

Lina Kalalo, Diana Takumansang-Sondakh, Audrey Wahani

AbstractBackgroundEnvironmental tobacco smoke has been consistently

linked to negative health outcomes, especially in children,

including an increased susceptibility to infections. Cigarette

smoking has a depressive effect on interferon-(IFN-). Serum

cotinine is a marker of exposure to smoke.

ObjectiveTo determine the association between serum cotinine

and interferon-(IFN-) levels in children with household tobacco

smoke exposure.

Methods We conducted a cross-sectional study at the Tumumpa

and Singkil Districts of Manado, Indonesia, from February to

May 2012. Subjects were collected by consecutively sampling of

healthy children aged 1-3 years who came to the integrated health

posts. Seventy-four children were recruited and consisted of twogroups of 37 subjects each, the tobacco smoke exposure group and

the non-tobacco smoke exposure group. Blood specimens were

collected from all subjects for laboratory blood tests of cotinine

and IFN- levels. Results were analyzed by T-test and Pearsons

correlation analysis with a P

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Lina Kalalo et al: Cotinine and interferon-levels in children exposed to tobacco smoke

288 Paediatr Indones, Vol. 53, No. 5, September 2013

biomarker for environmental tobacco smoke or

secondhand smoke and reflects exposure to nicotine

largely from the previous 1 to 2 days. Plasma cotininelevels lower than 15 mg/mL (85 nmol/L) is considered

to be exposure to environmental tobacco some in the

agsence of smoking.5,6

The depressive effects of cigarette smoking oninterferon-gamma (IFN-), was confirmed by an

in vivo study that found decreased IFN- levels inchildren whose parents smoked compared to that

of children of non-smokers.3 IFN- is a cytokine

produced primarily by activated CD4+ or CD8+ T

cells and natural killer cells, and is recognized as a chiefmediator of innate as well as adaptive immunity. IFN-

is an important cytokine in the host defense against

viral and microbial pathogens. It induces a variety ofphysiologically significant responses that contribute to

immunity. Among the biological activities of IFN-ismacrophage activation.7-9There have been conflicting reports on the

effects of nicotine on cytokines. Previous studies

revealed that nicotine, one of the main constituentsof cigarette smoke, disrupts the differentiation and

functional properties of monocyte-derived dendritic

cells, leading to decreased Th1 cytokine production,such as IFN-. There have been few studies on the

effect of tobacco smoke exposure in Indonesian pre-

school children, especially in Manado.The aim of this study was to assess the association

between serum cotinine and interferon- (IFN-)levels in children with household tobacco smokeexposure.

Methods

We conducted a cross-sectional study at the

Tumumpa and Singkil Districts of Manado fromFebruary to May 2012. A simple random sampling

method was used to select 4 out of the 48 integrated

health posts in the districts. Information on parental

smoking was collected at the time of enrollment.

Smokers were either mothers or fathers of the

children, both parents, or any primary caregivers,usually grandmothers, grandfathers or other

relatives. Parents were asked to clearly specify when

the caregivers started smoking, how many cigarettes

were smoked per day, and how many of these weresmoked in the presence of the children. Serum

cotinine was used to confirm the tobacco smokeexposure in children.

Children were classified as exposed to tobacco

smoke if they had been exposed to the smoke of one

or more cigarettes per day and had a plasma cotininelevel of 1-10 ng/mL. Children with cotinine levels of

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Paediatr Indones, Vol. 53, No. 5, September 2013 289

years, and that of the non-tobacco smoke exposure

group was 2.70 (SD 0.85) years.

The mean cotinine level in subjects exposedto tobacco smoke was 1.77 (SD 0.47) ng/mL. There

was no significant correlation between cotinine level

and IFN-level in subjects exposed to tobacco smoke

(r= -0.05; P=0.37). (Data not shown.) However,there was a significantly lower mean IFN- level

in the group exposed to tobacco smoke than in thegroup not exposed to tobacco smoke, (P

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290 Paediatr Indones, Vol. 53, No. 5, September 2013

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